CARDIOVASCULAR DRUGS!!!!!

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CARDIOVASCULAR DRUGS!!!!!
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Methyldopa

• Use?
• SE?

• Sympathoplegic, HTN
• Sedation, positive coombs test

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Reserpine

• Use?
• SE?

• Sympathoplegic, HTN
• Sedation, depression, nasal stuffiness, diarrhea

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Hydrochlorothiazide

• Use?
• SE?

• Diuretic, HTN
• Hypo-K, Hyperlipidemia, hyperuricemia, lassitude,
  Hyper-Ca, Hyperglycemia

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Clonidine

• Use?
• SE?

• Sympathoplegic, HTN
• Dry mouth, sedation, severe rebound HTN

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Guanethidine

• Use?
• SE?

• Sympathoplegic, HTN
• Orthostatic exercise hypotension, diarrhea,
  sexual dysfxn ?

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Nitroglycerin, Isosorbide Dinitrate

• Use?
• MOA?
• Decreased Preload or Afterload?
• Toxicity

• Vasodilatorangina, pulm edema,
  aphrodisiac/erection enhancer ?
• Releases NO from smooth muscle increased cGMP ?
  relaxation. Veinsgt Arteries
• Which does Arteries gt Veins?
• HYDRALAZINE
• PRELOAD
• Tachycardia, Flushing, HA, hypotension, Monday
  Diseasedecreased tolerance over weekend ? tach,
  dizziness and HA on reexposure

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Prazosin

• Use?
• SE?

• Sympathoplegic, HTN
• Orthostatic hypotension with 1st dose, dizziness,
  headache

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Diazoxide

• Use?
• SE?

• Vasodilator, HTN
• Hyperglycemia, decreased insulin release,
  hypotension

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Beta blockers

• Use?
• SE?

• Sympathoplegic, HTN
• Impotence ?, asthma, cardiovascular effects
  (bradycardia, CHF, AV block), CNS
  effectssedation and changes in sleep

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Hydralazine

• Use?
• Mechanism of Action?
• Reduces preload or afterload?
• SE?

• Vasodilator, severe HTN, CHF
• Increased cGMP ? smooth muscle relaxation.
  Arterioles gt veins.
• AFTERLOAD (Vasodilator!)
• Nausea, Headache, Lupus-like syndrome, reflex
  tachycardia (dont use in agina or CAD!), angina,
  salt retention
• Use with beta blocker to avoid tachycardia and
  with a diuretic to avoid salt retention

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Minoxidil

• Use?
• Mechanism of Action?
• SE?

• Vasodilator, HTN
• K channel opener, hyperpolarizes smooth muscle
  cells
• HAIRY MONSTER, pericardial effusion, reflex
  tachycardia, angina, salt retention
• Use with beta blocker to avoid tachycardia and
  with a diuretic to avoid salt retention

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Captopril

• Use?
• Other Examples?
• SE?

• ACE Inhibitor, HTN
• Enalapril, Fosinopril
• Hyper-K, cough, angioedema, taste changes,
  hypotension, fetal renal damage, rash, increased
  renin

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Hexamethonium

• Use?
• SE?

• Sympathoplegic, HTN
• Severe orthostatic hypotension, blurry vision,
  constipation, sexual dysfxn ?

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Verapamil

• Use?
• MOA?
• More cardiac or smooth muscle effects?
• SE?
• Toxicity?

• Calcium Channel Blocker, HTN, angina,
  arrhythmias, Raynauds
• Blocks Voltage Dependant L-type Ca channels,
  decreasing contractility
• Cardiac, but also vasodilator
• Dizziness, flushing, constipation, AV block,
  Nausea
• Cardiac depression, peripheral edema, flushing,
  dizziness, constipation

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HOW DO YOU TREAT MALIGNANT HYPERTENSION???

• Three drugs in alphabetical order
• 1 DIAZOXIDE
• MOA?
• K channel openerhyperpolarizes smooth muscle
• 2 Fenoldopam
• MOA?
• Dopamine1 Receptor Agonist relaxes vascular
  smooth muscle
• 3 Nitroprusside
• MOA?
• Increased cGMP via direct NO release
• SE?
• CYANIDE POISONING!!!

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Nitroprusside

• Use?
• SE?

• Vasodilator, HTN
• Cyanide Poisoning (Releases CN!)

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WHICH TWO DRUGS ARE THE HYPERTENSION IN PREGNANCY
SUPERSTAR MEDS?(Which are ok to use in
Pregnancy?)

• HYDRALAZINE METHYLDOPA

This, on the other hand is NOT safe in
pregnancy. ?
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Diltiazem

• Use?
• MOA?
• More cardiac or smooth muscle effects?
• SE?
• Toxicity?

• Calcium Channel Blocker, HTN, angina,
  arrhythmias, Raynauds
• Blocks Voltage Dependant L-type Ca channels,
  decreasing contractility
• Somewhere in the middle
• Dizziness, flushing, constipation, AV block,
  Nausea
• Cardiac depression, peripheral edema, flushing,
  dizziness, constipation

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Losartan

• Use?
• Good alternative to what?
• SE?

• Angiotensin II Receptor Blocker, HTN
• ACE Inhibitors
• Fetal renal toxicity, Hyper-K

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Nifedipine

• Use?
• MOA?
• More Cardiac or Smooth Muscle Effects?
• SE?
• Toxicity?

• Calcium Channel Blocker, HTN, angina, Raynauds
• Blocks Voltage Dependant L-type Ca channels,
  decreasing contractility
• Smooth musclevasodilator
• Dizziness, flushing
• Cardiac depression, peripheral edema, flushing,
  dizziness, constipation

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CHOLESTEROL DRUGS

• Which is best for decreased triglycerides?
• Fibrates
• Examples?
• Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate
• Which are best for decreasing LDL?
• Statins
• MOA?
• HMG CoA reductase inhibitorsinhibit cholestrol
  precursor mevalonate
• Which do patients hate taking because of GI
  disturbances?
• Bile Acid Resins Cholestyramine Colestipol
• What are two other possible drugs you could use?
• Cholesterol Absorption Blockers (Ezetimibe) and
  Niacin

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Anti-arrhythmicsBIG PICTURE
CLASS General MOA
Class I
Class II
Class III
Class IV
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Anti-arrhythmicsBIG PICTURE
CLASS General MOA
Class I Block FAST sodium channels responsible for phase 0 depolarization Quinidine, Flecanide, Procainamide
Class II
Class III
Class IV
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Anti-arrhythmicsBIG PICTURE
CLASS General MOA
Class I Block FAST sodium channels responsible for phase 0 depolarization Quinidine, Flecanide, Procainamide
Class II Beta Adrenergic Receptor AntagonistsPropranolol, Metoprolol
Class III
Class IV
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Anti-arrhythmicsBIG PICTURE
CLASS General MOA
Class I Block FAST sodium channels responsible for phase 0 depolarization Quinidine, Flecanide, Procainamide
Class II Beta Adrenergic Receptor Antagonists Propranolol, Metoprolol
Class III Prolong action potential with little effect on phase 0 depolarization, mostly via blocking the K repolarizing current Amiodarone, Sotalol, Ibutilide
Class IV
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Anti-arrhythmicsBIG PICTURE
CLASS General MOA
Class I Block FAST sodium channels responsible for phase 0 depolarization Quinidine, Flecanide, Procainamide
Class II Beta Adrenergic Receptor Antagonists Propranolol, Metoprolol
Class III Prolong action potential with little effect on phase 0 depolarization, mostly via blocking the K repolarizing current Amiodarone, Sotalol, Ibutilide
Class IV Block slow L-type Calcium Channels Verapamil, Diltiazem
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Class I Drugs Broken up by degree of Na channel
blockade and effect on AP duration

• CLASS IA Drugs
• MOA?
• Moderate blockade of Na channels raise AP
  threshold and slow AP upstroke. Also depress
  slope of phase 4 depolarization.
• Uses?
• Ectopic foci and reentrant rhythms
• Atrial AND Ventricular Arrhythmias
• Examples?
• Quinidine, Amiodarone, Procainamide, Disopyramide
• SE
• Quinidine
• Cinconchism HA, tinnitus, thrombocytopenia
• Increase AP duration, increased effective
  refractory period, increase QT interval
  (increased risk of what?)
• Torsades de points
• Procainamide
• Reversible SLE-like syndrome

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Class I Drugs Broken up by degree of Na channel
blockade and effect on AP duration

• CLASS IB Drugs
• MOA?
• Bold Na channels, but unlike IAs shorten
  duration of AP and refractory period
• Uses?
• Preferentially act on diseased tissue ischemic
  or depolarized Purkinje/ventricular tissue.
• Great post-MI and for dig-induced arrhythmias
• Examples?
• Lidocaine, Mexiletine, Tocainide, Phenytoin?
• SE
• CNS depression/stim and cardiovasc depression

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Class I Drugs Broken up by degree of Na channel
blockade and effect on AP duration

• CLASS IC Drugs
• MOA?
• Most potent sodium channel blockers! Decrease
  upstroke of AP and conduction velocity
  everywhere!
• No change in AP duration
• Uses?
• Vtachs that progress to VF and intractable SVT
• LAST RESORT FOR REFRACTORY TACHYARRHYTHMIAS
• Examples?
• Flecanide, Encainide, Propafenone
• SE
• Proarrhythmic, esp post MI avoid in those with
  heart disease?increased mortality!
• Prolonged refractory period in AV node.

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Class II Drugs

• MOA?
• Beta blockers decreased cAMP and Ca currents.
  Decrease slope of phase 4 depolarization. AV
  node very sensitive.
• Uses?
• Abnormal pacemakers, Vtach, SVT, slow ventricular
  rate in a-fib or a-flutter
• Examples?
• Propranolol, Esmolol, Metoprolol, Atenolol,
  Timolol
• Which one is super short acting?
• ESMOLOL
• SE
• Impotence ?, asthma exacerbation, bradycardia, AV
  block, CHF,sedation, sleep changes
• Why use with caution in diabetics?
• Mask effects of hypoglycemia
• Metoprolol
• Dyslipidemia

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Class III Drugs

• MOA?
• Potassium Channel Blockers increase AP duration
• Uses?
• used when other drugs fail
• Examples?
• Sotalol, Ibutilide, Bretylium, Amiodarone
• Which is good for Wolf-Parkinson-White?
• Amiodarone
• SE
• Sotalol
• Increased QT Intervalwhy is this bad?
• Increased risk of torsades de points
• Excessive beta block
• Ibutilide
• Torsades
• Bretylium
• Arrhythmias, hypotension
• Amiodarone
• Pulm fibrosis, corneal deposits, Hepatotoxicity,
  photodermatitis, Neuro SE, constipation,
  bradycardia, heart block, hypothyroid,
  hyperthyroid

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Class IV Drugs

• MOA?
• Calcium Channel Blockers AV node decreased
  conduction.
• Uses?
• Especially good for?
• SVTs
• Examples?
• Verapamil and Diltiazem for Anti-arrhythmics
• SE
• Constipation, flushing, edema, CV effects,
  torsades

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Adenosine

• MOA
• Increased K efflux hyperpolarization.
• Drug of choice for which conditions?
• AV nodal arrhythmias.
• Short or long acting?
• Very short (15 Seconds)
• Toxicity
• Flushing, Hypotension, Chest pain

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Potassium

• MOA
• Decreases ectopic pacers in hypokalemia
• Drug of choice for which conditions?
• Dig toxicity

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Magnesium

• Drug of choice for which conditions?
• Torsades and dig toxicity